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Molecular subgroup of primary prostate cancer presenting with metastatic biology

Walker, Steven M., Knight, Laura A., McCavigan, Andrena M., Logan, Gemma E., Berge, Viktor, Sherif, Amir, Pandha, Hardev, Warren, Anne Y., Davidson, Catherine, Uprichard, Adam, Blayney, Jaine K., Price, Bethanie, Jellema, Gera L., Steele, Christopher J., Svindland, Aud, McDade, Simon S., Eden, Christopher G., Foster, Chris, Mills, Ian G., Neal, David E., Mason, Malcolm David, Kay, Elaine W., Waugh, David J., Harkin, D. Paul, Watson, R. William, Clarke, Noel W. and Kennedy, Richard D. 2017. Molecular subgroup of primary prostate cancer presenting with metastatic biology. European Urology 72 (4) , pp. 509-518. 10.1016/j.eururo.2017.03.027

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BACKGROUND: Approximately 4-25% of patients with early prostate cancer develop disease recurrence following radical prostatectomy. OBJECTIVE: To identify a molecular subgroup of prostate cancers with metastatic potential at presentation resulting in a high risk of recurrence following radical prostatectomy. DESIGN, SETTING, AND PARTICIPANTS: Unsupervised hierarchical clustering was performed using gene expression data from 70 primary resections, 31 metastatic lymph nodes, and 25 normal prostate samples. Independent assay validation was performed using 322 radical prostatectomy samples from four sites with a mean follow-up of 50.3 months. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Molecular subgroups were identified using unsupervised hierarchical clustering. A partial least squares approach was used to generate a gene expression assay. Relationships with outcome (time to biochemical and metastatic recurrence) were analysed using multivariable Cox regression and log-rank analysis. RESULTS AND LIMITATIONS: A molecular subgroup of primary prostate cancer with biology similar to metastatic disease was identified. A 70-transcript signature (metastatic assay) was developed and independently validated in the radical prostatectomy samples. Metastatic assay positive patients had increased risk of biochemical recurrence (multivariable hazard ratio [HR] 1.62 [1.13-2.33]; p=0.0092) and metastatic recurrence (multivariable HR=3.20 [1.76-5.80]; p=0.0001). A combined model with Cancer of the Prostate Risk Assessment post surgical (CAPRA-S) identified patients at an increased risk of biochemical and metastatic recurrence superior to either model alone (HR=2.67 [1.90-3.75]; p<0.0001 and HR=7.53 [4.13-13.73]; p<0.0001, respectively). The retrospective nature of the study is acknowledged as a potential limitation. CONCLUSIONS: The metastatic assay may identify a molecular subgroup of primary prostate cancers with metastatic potential. PATIENT SUMMARY: The metastatic assay may improve the ability to detect patients at risk of metastatic recurrence following radical prostatectomy. The impact of adjuvant therapies should be assessed in this higher-risk population

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Uncontrolled Keywords: Metastatic assay; Prognostic; Progression; Prostate cancer; Recurrence.
Additional Information: This is an open access article under the CC BY-NC-ND license
Publisher: Elsevier
ISSN: 0302-2838
Date of First Compliant Deposit: 11 August 2017
Date of Acceptance: 17 March 2017
Last Modified: 11 Jul 2019 13:13

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